Pieces of a U.S. Maternal Health Plan Take Shape

(WOMENSENEWS)–Eleanor Hinton Hoytt knows all about negative U.S. maternal mortality statistics and she hopes that health reform–with help from a bill in Congress–can do something about it.

"Until recently we haven’t had a national plan for addressing maternal health," says Hinton Hoytt, CEO of the Washington-based Black Women’s Health Imperative. "We deal only with morbidity and mortality rather than putting in place a way to make sure that people have what they need."

Hinton Hoytt spoke with Women’s eNews by phone following her participation at a May congressional briefing on a bill–separate from health reform–that would prod states to study the rising problem of U.S. women dying from causes related to pregnancy and childbirth.

That bill, she says, will provide the means to collect data to make health reform programs for women–such as home visits during pregnancy and community health centers–more responsive to women’s needs. Called the Maternal Health Accountability Act, the bill would give states funding to research their own maternal mortality statistics.

Hinton Hoytt said the bill would also help reveal underlying causes of maternal mortality for which she gives many examples: domestic violence, unemployment, discrimination in the workplace and "environmental toxins in which black women and poor women live."

"Those social determinants of health are real," says Hinton Hoytt. "This bill deals with that indirectly because once you have a way of collecting data then you can identify some of those social factors that impact what is going on and, therefore, begin to understand and address some of the assumptions that we have about these kinds of health disparities."

Hinton Hoytt added that even among women who have health insurance and good pre-natal care, some die or experience severe complications.

$10 Million in Funding

The Maternal Health Accountability Act (HR 894) authorizes $10 million in new funding annually between 2012 and 2018 to help states pay closer attention to the reasons why women die from causes related to childbirth and pregnancy.

States would have the option to participate. Only about half the states currently collect some of the data the act would require.

The funding would pay for state review committees composed of health professionals, social workers and members of affected communities to recommend prevention strategies and disseminate findings and recommendations. The bill would also create a program aimed at eliminating disparities in maternal deaths and negative health impacts.

The Maternal Health Accountability Act draws on a report, "Deadly Delivery: The Maternal Health Care Crisis in the USA," that Amnesty International released in 2010 and updated this year. It found that women living in low-income areas are twice as likely to suffer maternal deaths as women living in high-income areas.

Black women are three to four times more likely to die from pregnancy-related causes than white women, a statistic that Nan Strauss, lead researcher of the Amnesty report, says hasn’t changed in the past 60 years.

The report also notes that problems are tied to well-known barriers to care, such as financial constraints, lack of medical professionals where the women live, lack of transportation to doctors’ appointments and lack of child care. But it also targets issues such as jobs that don’t offer women the flexibility to make health care appointments.

Report Spurs Briefing

Amnesty International USA, which regards maternal care as a basic human right, spurred the recent briefing on the bill, held by Rep. John Conyers, D-Mich. Strauss says Amnesty International’s interest in the issue began with its global Demand Dignity campaign to end human rights abuses linked to poverty.

"As part of that we have taken up specific issues, including maternal mortality, in countries like Sierra Leone, Burkina Faso, Indonesia, Peru and others," Strauss says. "But, as with all issues, Amnesty International feels strongly that human rights are not a framework that applies only to other countries but one that we need to use to look at issues confronting us in our own back yard."

Strauss adds that they began by looking at global data from the U.N. on maternal mortality and it quickly became very clear "which wealthy country is falling behind in that area. The U.S. spends the most on maternal care of any country, with results that don’t match that investment."

The United States is tied with Saudi Arabia in maternal mortality, according to the U.N. data, with both sharing the rank of having the 50th highest maternal mortality rates globally, meaning 49 other countries have better statistics.

The pregnancy-related maternal mortality rate, the report found, in the United States was 24 per 100,000 live births from 1990 through 2008. Greece had the best outcomes, at two deaths per 100,000 live births; Afghanistan was worst, with an estimated 1,400 women dying per 100,000 live births.

Daily Maternal Deaths

The high U.S. rate means two to three women die of pregnancy-related causes every day in the country and 34,000 women suffer life-threatening complications each year during pregnancy or childbirth.

The Amnesty report notes that people who live in middle-income areas in the U.S. have a 58 percent higher risk of pregnancy-related death than those in high-income areas.

It also finds that that the majority of maternal deaths are preventable, from causes such as hemorrhage, pulmonary embolism, pre-eclampsia and eclampsia, which can be related to lack of pre-natal care or lack of quality care.

Other deaths, making up the minority, result from complications that are not considered preventable, like amniotic fluid embolism or aneurism.

"States that have higher than the national average C-section rate, which is now 33 percent, have a 21 percent higher risk of maternal mortality," Strauss says.

The Maternal Accountability Act has 41 co-sponsors so far, including one Republican, freshman Congressman Andy Harris of Maryland, who’s a physician.

Survivors of women who have died from pregnancy-related causes spoke at the briefing alongside congressional staffers, physicians and community activists.

Getting hospitals to stop estimating blood loss and start quantifying it—going from “EBL to QBL”–is now a major goal of an effort to reduce postpartum hemorrhage, a leading cause of maternal death that disproportionately afflicts black women.

In Case You Missed It

It is being hailed as the most progressive state policy so far, going further than New Jersey, California and Rhode Island in various respects. But its showcase potential won’t be tested until the program gets going in 2018.